SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England. (May 2022)

• Record Type: Journal Article
• Authors: Stenton, Sophie; McPartland, Jo; Shukla, Rajeev; Turner, Kerry; Marton, Tamas; Hargitai, Beata; Bamber, Andrew; Pryce, Jeremy; Peres, Cesar L; Burguess, Nadia; Wagner, Bart; Ciolka, Barbara; Simmons, William; Hurrell, Daniel; Sekar, Thivya; Moldovan, Corina; Trayers, Claire; Bryant, Victoria; Palm, Liina; Cohen, Marta C
• Is Part Of: EClinicalMedicine. Volume 47(2022)
• Publication Date: 2022-05
• Subjects: COVID-19 -- Chronic histiocytic intervillositis -- Massive perivillous fibrin deposition -- Placentitis -- SARS-CoV2 -- Stillbirth; Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2022.101389
• Languages: English
• ISSNs: 2589-5370

Abstract

Summary: Background: Pregnant women with SARS-CoV-2 infection experience higher rates of stillbirth and preterm birth. A unique pattern of chronic histiocytic intervillositis (CHI) and/or massive perivillous fibrin deposition (MPFD) has emerged, coined as SARS-CoV-2 placentitis. Methods: The aim of this study was to describe a cohort of placentas diagnosed with SARS-CoV-2 placentitis during October 2020-March 2021. Cases with a histological diagnosis of SARS-CoV-2 placentitis and confirmatory immunohistochemistry were reported. Maternal demographic data, pregnancy outcomes and placental findings were collected. Findings: 59 mothers delivered 61 infants with SARS-CoV-2 placentitis. The gestational age ranged from 19 to 41 weeks with most cases (78.6%) being third trimester. 30 infants (49.1%) were stillborn or late miscarriages. Obese mothers had higher rates of pregnancy loss when compared with those with a BMI <30 [67% (10/15) versus 41% (14/34)]. 47/59 (79 . 7%) mothers had a positive SARS-CoV-2 PCR test either at the time of labour or in the months before, of which 12 (25 . 5%) were reported to be asymptomatic. Ten reported only CHI, two cases showed MPFD only and in 48 placentas both CHI and MPFD was described. Interpretation: SARS-CoV2 placentitis is a distinct entity associated with increased risk of pregnancy loss, particularly in the third trimester. Women can be completely asymptomatic and still experience severe placentitis. Unlike 'classical' MPFD, placentas with SARS-CoV-2 are generally normal in size with adequate fetoplacental weight ratios. Further work should establish the significance of the timing of maternal SARS-CoV-2 infection and placentitis, the significance of SARS-CoV2 variants, and rates of vertical transmission associated with this pattern of placental inflammation. Funding: There was not funding associated with this study.